Provider Demographics
NPI:1518267541
Name:ERASMUS, CLINTON (PTA)
Entity Type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:ERASMUS
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4747 N OCEAN DRIVE
Mailing Address - Street 2:SUITE 261
Mailing Address - City:LAUDERDALE BY THE SEA
Mailing Address - State:FL
Mailing Address - Zip Code:33308-2956
Mailing Address - Country:US
Mailing Address - Phone:954-545-4922
Mailing Address - Fax:954-545-4923
Practice Address - Street 1:4747 N OCEAN DRIVE
Practice Address - Street 2:SUITE 261
Practice Address - City:LAUDERDALE BY THE SEA
Practice Address - State:FL
Practice Address - Zip Code:33308-2956
Practice Address - Country:US
Practice Address - Phone:954-545-4922
Practice Address - Fax:954-545-4923
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA19828225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA19828OtherLICENSE